CPAP 与氧疗治疗阻塞性睡眠呼吸暂停的比较。
CPAP versus oxygen in obstructive sleep apnea.
机构信息
From the Veterans Affairs Boston Healthcare System (D.J.G., D.L.B.), Brigham and Women's Hospital (D.J.G., S.R.P., S.F.Q., M.R., E.F.L., D.L.B., S.R.), Harvard Medical School (D.J.G., S.R.P., S.F.Q., E.F.L., D.L.B., S.R.), Boston University School of Medicine (D.J.G.), and Beth Israel Deaconess Medical Center (S.R.P., S.R.) - all in Boston; Johns Hopkins University, Baltimore (N.M.P., R.S.B.); Cleveland Clinic (R.M.) and Case Western Reserve University (R.M., D.C.B.) - both in Cleveland; and the University of Vermont, Colchester (R.P.T.).
出版信息
N Engl J Med. 2014 Jun 12;370(24):2276-85. doi: 10.1056/NEJMoa1306766.
BACKGROUND
Obstructive sleep apnea is associated with hypertension, inflammation, and increased cardiovascular risk. Continuous positive airway pressure (CPAP) reduces blood pressure, but adherence is often suboptimal, and the benefit beyond management of conventional risk factors is uncertain. Since intermittent hypoxemia may underlie cardiovascular sequelae of sleep apnea, we evaluated the effects of nocturnal supplemental oxygen and CPAP on markers of cardiovascular risk.
METHODS
We conducted a randomized, controlled trial in which patients with cardiovascular disease or multiple cardiovascular risk factors were recruited from cardiology practices. Patients were screened for obstructive sleep apnea with the use of the Berlin questionnaire, and home sleep testing was used to establish the diagnosis. Participants with an apnea-hypopnea index of 15 to 50 events per hour were randomly assigned to receive education on sleep hygiene and healthy lifestyle alone (the control group) or, in addition to education, either CPAP or nocturnal supplemental oxygen. Cardiovascular risk was assessed at baseline and after 12 weeks of the study treatment. The primary outcome was 24-hour mean arterial pressure.
RESULTS
Of 318 patients who underwent randomization, 281 (88%) could be evaluated for ambulatory blood pressure at both baseline and follow-up. On average, the 24-hour mean arterial pressure at 12 weeks was lower in the group receiving CPAP than in the control group (-2.4 mm Hg; 95% confidence interval [CI], -4.7 to -0.1; P=0.04) or the group receiving supplemental oxygen (-2.8 mm Hg; 95% CI, -5.1 to -0.5; P=0.02). There was no significant difference in the 24-hour mean arterial pressure between the control group and the group receiving oxygen. A sensitivity analysis performed with the use of multiple imputation approaches to assess the effect of missing data did not change the results of the primary analysis.
CONCLUSIONS
In patients with cardiovascular disease or multiple cardiovascular risk factors, the treatment of obstructive sleep apnea with CPAP, but not nocturnal supplemental oxygen, resulted in a significant reduction in blood pressure. (Funded by the National Heart, Lung, and Blood Institute and others; HeartBEAT ClinicalTrials.gov number, NCT01086800 .).
背景
阻塞性睡眠呼吸暂停与高血压、炎症和心血管风险增加有关。持续气道正压通气（CPAP）可降低血压，但患者的依从性往往并不理想，并且其益处超出了常规危险因素管理的范围仍不确定。由于间歇性低氧血症可能是睡眠呼吸暂停心血管后果的基础，我们评估了夜间补充氧气和 CPAP 对心血管风险标志物的影响。
方法
我们进行了一项随机对照试验，招募了来自心脏病学诊所的患有心血管疾病或多种心血管危险因素的患者。使用柏林问卷筛查患者的阻塞性睡眠呼吸暂停，并用家庭睡眠测试来确诊。呼吸暂停低通气指数为 15 至 50 次/小时的参与者被随机分配接受睡眠卫生和健康生活方式教育（对照组），或在接受教育的基础上，接受 CPAP 或夜间补充氧气。在研究治疗开始时和 12 周后评估心血管风险。主要结局是 24 小时平均动脉压。
结果
在 318 名接受随机分组的患者中，有 281 名（88%）能够在基线和随访时评估动态血压。平均而言，接受 CPAP 治疗的患者在 12 周时的 24 小时平均动脉压低于对照组（-2.4mmHg；95%置信区间 [CI]，-4.7 至 -0.1；P=0.04）或补充氧气组（-2.8mmHg；95% CI，-5.1 至 -0.5；P=0.02）。对照组与接受氧疗组之间的 24 小时平均动脉压无显著差异。使用多种插补方法进行的敏感性分析来评估缺失数据的影响并未改变主要分析的结果。
结论
在患有心血管疾病或多种心血管危险因素的患者中，用 CPAP 治疗阻塞性睡眠呼吸暂停可显著降低血压，但夜间补充氧气则不然。（由美国国立心肺血液研究所等资助；HeartBEAT ClinicalTrials.gov 编号，NCT01086800）。
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